Glomerular filtration rate, blood pressure and microalbuminuria in adults born SGA: A 5‐year longitudinal study after cessation of GH treatment

Goedegebuure, Wesley J; Kerkhof, Gerthe F.; Hokken-Koelega, Anita C S

doi:10.1111/cen.14095

Cited by 4 publications

(6 citation statements)

References 35 publications

(54 reference statements)

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“…Glomerular filtration rate, blood pressure and urinary albumin-to-creatinine ratio at the age of 21 years is similar between young adults born SGA and those born AGA ( 77 ).…”

Section: Consequences Of Being Born Sgamentioning

confidence: 88%

“…There are few papers about the long-term cardiometabolic health of young adults born SGA after cessation of GH treatment due to adult height attainment in comparison with appropriate control groups ( 75 , 77 , 204 , 245 ). Since GH treatment has cardiometabolic effects and raises serum concentrations of IGF-I concentrations, which is mitogenic and antiapoptotic, there have been concerns about the long-term side effects of GH treatment even after cessation of treatment.…”

Section: Clinical Management Of Children Born Sgamentioning

confidence: 99%

“…Since GH treatment has cardiometabolic effects and raises serum concentrations of IGF-I concentrations, which is mitogenic and antiapoptotic, there have been concerns about the long-term side effects of GH treatment even after cessation of treatment. Until now, there is one large Dutch cohort of 199 previously GH-treated young adults born SGA, who were followed for 5 to 12 years after cessation of childhood GH treatment ( 75 , 77 , 204 , 245 , 246 ). At 5 and 12 years after cessation, at the age of 21 and 30 years, their data were also compared with 285 age-matched untreated controls, consisting of SGA-born subjects with either persistent short stature or normal stature after spontaneous catch-up during childhood and AGA-born young adults ( Fig.…”

Section: Clinical Management Of Children Born Sgamentioning

confidence: 99%

See 2 more Smart Citations

International Consensus Guideline on Small for Gestational Age: Etiology and Management From Infancy to Early Adulthood

et al. 2023

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This International Consensus Guideline was developed by experts in the field of SGA of 10 pediatric endocrine societies worldwide. A consensus meeting was held and 1300 articles formed the basis for discussions. All experts voted about the strengths of the recommendations. The guideline gives new and clinically relevant insights into the etiology of short stature after SGA birth, including novel knowledge about (epi)genetic causes. Besides, it presents long-term consequences of SGA birth and new treatment options, including treatment with gonadotropin-releasing hormone agonist (GnRHa) in addition to growth hormone (GH) treatment, and the metabolic and cardiovascular health of young adults born SGA after cessation of childhood-GH-treatment in comparison with appropriate control groups. To diagnose SGA, accurate anthropometry and use of national growth charts are recommended. Follow-up in early life is warranted and neurodevelopment evaluation in those at risk. Excessive postnatal weight gain should be avoided, as this is associated with an unfavorable cardio-metabolic health profile in adulthood. Children born SGA with persistent short stature < -2.5 SDS at age 2 years or < -2 SDS at age of 3-4 years, should be referred for diagnostic work-up. In case of dysmorphic features, major malformations, microcephaly, developmental delay, intellectual disability and/or signs of skeletal dysplasia, genetic testing should be considered. Treatment with 0.033–0.067 mg GH/kg/day is recommended in case of persistent short stature at age of 3-4 years. Adding GnRHa treatment could be considered when short adult height is expected at pubertal onset. All young adults born SGA require counseling to adopt a healthy lifestyle.

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“…Glomerular filtration rate, blood pressure and urinary albumin-to-creatinine ratio at the age of 21 years is similar between young adults born SGA and those born AGA ( 77 ).…”

Section: Consequences Of Being Born Sgamentioning

confidence: 88%

Section: Clinical Management Of Children Born Sgamentioning

confidence: 99%

Section: Clinical Management Of Children Born Sgamentioning

confidence: 99%

See 1 more Smart Citation

International Consensus Guideline on Small for Gestational Age: Etiology and Management From Infancy to Early Adulthood

et al. 2023

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“…Furthermore, GH treatment has positive effects on the kidney development since it leads to an increased renal length and volume. Moreover, after cessation of GH treatment the renal function has been shown to be comparable between SGA patients who received GH and healthy controls (159).…”

Section: Growth Hormone Treatmentmentioning

confidence: 94%

Highlighting the trajectory from intrauterine growth restriction to future obesity

Gantenbein

Kanaka-Gantenbein

2022

Front. Endocrinol.

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During the last decades several lines of evidence reported the association of an adverse intrauterine environment, leading to intrauterine restriction, with future disease, such as obesity and metabolic syndrome, both leading to increased cardiovascular and cancer risk. The underlying explanation for this association has firstly been expressed by the Barker’s hypothesis, the “thrifty phenotype hypothesis”. According to this hypothesis, a fetus facing an adverse intrauterine environment adapts to this environment through a reprogramming of its endocrine-metabolic status, during the crucial window of developmental plasticity to save energy for survival, providing less energy and nutrients to the organs that are not essential for survival. This theory evolved to the concept of the developmental origin of health and disease (DOHaD). Thus, in the setting of an adverse, f. ex. protein restricted intrauterine environment, while the energy is mainly directed to the brain, the peripheral organs, f.ex. the muscles and the liver undergo an adaptation that is expressed through insulin resistance. The adaptation at the hepatic level predisposes to future dyslipidemia, the modifications at the vascular level to endothelial damage and future hypertension and, overall, through the insulin resistance to the development of metabolic syndrome. All these adaptations are suggested to take place through epigenetic modifications of the expression of genes without change of their amino-acid sequence. The epigenetic modifications leading to future obesity and cardiovascular risk are thought to induce appetite dysregulation, promoting food intake and adipogenesis, facilitating obesity development. The epigenetic modifications may even persist into the next generation even though the subsequent generation has not been exposed to an adverse intrauterine environment, a notion defined as the “transgenerational transfer of environmental information”. As a consequence, if the increased public health burden and costs of non-communicable chronic diseases such as obesity, hypertension, metabolic syndrome and type 2 diabetes have to be minimized, special attention should be laid to the healthy lifestyle habits of women of reproductive age, including healthy diet and physical activity to be established long before any pregnancy takes place in order to provide the best conditions for both somatic and mental health of future generations.

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“…Concern has been raised that children treated for short stature not due to kidney diseases, receiving long-term rhGH-treatment may develop CKD in the long run. A recent, large, prospective study evaluated eGFR, blood pressure and microalbuminuria at 6 months, 2 years and 5 years after cessation of rhGH-treatment in adults born small for gestational age (SGA) [ 220 ]. A significant decrease in eGFR was noted at 6 months only.…”

Section: Pathophysiology Of Ghmentioning

confidence: 99%

Renal effects of growth hormone in health and in kidney disease

2021

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Growth hormone (GH) and its mediator insulin-like growth factor-1 (IGF-1) have manifold effects on the kidneys. GH and IGF receptors are abundantly expressed in the kidney, including the glomerular and tubular cells. GH can act either directly on the kidneys or via circulating or paracrine-synthesized IGF-1. The GH/IGF-1 system regulates glomerular hemodynamics, renal gluconeogenesis, tubular sodium and water, phosphate, and calcium handling, as well as renal synthesis of 1,25 (OH)2 vitamin D3 and the antiaging hormone Klotho. The latter also acts as a coreceptor of the phosphaturic hormone fibroblast-growth factor 23 in the proximal tubule. Recombinant human GH (rhGH) is widely used in the treatment of short stature in children, including those with chronic kidney disease (CKD). Animal studies and observations in acromegalic patients demonstrate that GH-excess can have deleterious effects on kidney health, including glomerular hyperfiltration, renal hypertrophy, and glomerulosclerosis. In addition, elevated GH in patients with poorly controlled type 1 diabetes mellitus was thought to induce podocyte injury and thereby contribute to the development of diabetic nephropathy. This manuscript gives an overview of the physiological actions of GH/IGF-1 on the kidneys and the multiple alterations of the GH/IGF-1 system and its consequences in patients with acromegaly, CKD, nephrotic syndrome, and type 1 diabetes mellitus. Finally, the impact of short- and long-term treatment with rhGH/rhIGF-1 on kidney function in patients with kidney diseases will be discussed.

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Glomerular filtration rate, blood pressure and microalbuminuria in adults born SGA: A 5‐year longitudinal study after cessation of GH treatment

Cited by 4 publications

References 35 publications

International Consensus Guideline on Small for Gestational Age: Etiology and Management From Infancy to Early Adulthood

International Consensus Guideline on Small for Gestational Age: Etiology and Management From Infancy to Early Adulthood

Highlighting the trajectory from intrauterine growth restriction to future obesity

Renal effects of growth hormone in health and in kidney disease

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